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SAN10 A Q U I N Environmental Health Department <br /> COUNTY <br /> i <br /> i <br /> I <br /> AUTHORIZATION TO RELEASE <br /> `i <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> !i <br /> *ENVIRONMENTAL/SITE ASSESSMENT INFORMATION E <br /> i <br /> i <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> (Street Address) (City) <br /> HERESY AUTHORIZE <br /> ,E�III(�o -e-f��r�'( irV� � ��1lAa�€�� (�o�.11d/ltaa�I��✓%�� <br /> (Laboratory) ' <br /> i <br /> i <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br /> SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. 4 <br /> r � <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: (- Lj) c t Alsl(,4l'� <br /> (Please Print) (Title) <br /> 14 i <br /> o <br /> C� <br /> U <br /> `7 2-6 ' <br /> doler/Operator Signatur (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> i <br />